It was exciting to see the volume of research examining the associations of PCEs with health outcomes, however we found notable gaps, especially when it came to looking at physical health outcomes. – Dina Burstein, MD, MPH, Project Director
First scoping review on PCEs and health outcomes
BOSTON, MA, January 17, 2025 – The HOPE National Resource Center, in collaboration with partners at the RAND Corporation and the Centers for Disease Control and Prevention (CDC), published the on positive childhood experiences (PCEs) and health outcomes, “Health Associations of Positive Childhood Experiences: A Scoping Review of the Literature,” in the International Journal of Environmental Research and Public Health. The review includes 220 publications investigating the associations between exposures to PCEs and health outcomes.
“It was exciting to see the volume of research examining the associations of PCEs with health outcomes, however we found notable gaps, especially when it came to looking at physical health outcomes,” says Dina Burstein, MD, MPH, Project Director of the HOPE National Resource Center. “Considering the substantial impact adverse childhood experiences (ACEs) have on physical health, addressing this gap is critically important.”
Applying the HOPE framework in research
The investigators used the HOPE framework to define and examine 23 types of PCEs relating to three Building Blocks of HOPE:
- Secure, nurturing relationships with adults and other children (e.g. being securely attached to a parent or caregiver)
- Safe, equitable, and stable environments to live, learn, and play (e.g. living in a safe neighborhood or community)
- Opportunities for social and civic engagement (e.g. having opportunity for extracurricular engagement with school or with the community)
(The fourth Build Building Block of HOPE – opportunities for emotional growth – was not included in the review.)
Similarly, the research team worked with the CDC to prioritize 10 health outcomes that could best provide important insights into PCEs. The selected health outcomes include:
- Mental health outcomes (e.g. depression, anxiety, PTSD)
- Behavioral health outcomes (e.g. substance misuse, suicidal behaviors)
- Violence victimization or perpetration
- Physical health outcomes (e.g. cardiovascular disease)
In total, the scoping review tested 795 associations between 23 PCEs and 10 health outcomes across 220 studies.
Results and considerations for future research
The Building Block of relationships was the most studied type of PCE, accounting for 52% of the tested associations, followed by environment (30%), engagement (14%), and other sub-categories of PCEs (3%). Most research focused on the topics of caregiver relationships and school environment. Further research on less frequently studied PCEs, particularly environment and social engagement factors relating to social determinants of health (SDoH), could help inform future public health policies in addressing SDoH by promoting these PCEs.
The most studied outcomes were mental and behavioral health. Substance misuse was studied in 38% of tested associations across 42% of studies, followed by suicidal behaviors (25% associations, 25% studies), and depression (14% associations, 25% studies). A lower level of research focused on other mental health outcomes (e.g. anxiety, PTSD), physical health outcomes, and violence victimization or perpetration. More research is needed to examine these less frequently studied health outcomes to understand and develop effective interventions and policies.
About HOPE – Healthy Outcomes from Positive Experiences
Based at Tufts Medical Center in Boston, Massachusetts, the HOPE National Resource Center sees a world that honors and promotes positive experiences as necessary for health and well-being. Research shows that positive childhood experiences (PCEs) drive healthy child development and lessen the lifelong effects of adverse childhood experiences (ACEs). HOPE aims to inspire a movement that changes how people and organizations advance health and well-being for children, families, and communities.
Robert Sege, MD, PHD, FAAP, Director of the Center for Community-Engaged Medicine at Tufts Medical Center and Professor of Medicine and Pediatrics at Tufts University School of Medicine, leads the HOPE National Resource Center.
Inquiries: HOPE@tuftsmedicalcenter.org
